Outcomes of CAR T-Cell Therapy in Relapsed/Refractory Multiple Myeloma by Race: A Multicenter Real-World Study

Outcomes of CAR T-Cell Therapy in Relapsed/Refractory Multiple Myeloma by Race: A Multicenter Real-World Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Outcomes of CAR T-Cell Therapy in Relapsed/Refractory Multiple Myeloma by Race: A Multicenter Real-World Study Manisha Bhutani, Hira Shaikh, Alma Habib, Andrew vegel, Ami Ndiaye, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7208369/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Nov, 2025 Read the published version in Blood Cancer Journal → Version 1 posted 10 You are reading this latest preprint version Abstract Racial and ethnic minorities have been underrepresented in pivotal trials of idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), limiting the generalizability of findings. This multicenter retrospective study evaluated real-world outcomes in minority patients (MP) versus White patients (WP) treated with cilta-cel or ide-cel across five U.S. centers between May 2022 and April 2024. Among 223 patients, 21% self-identified as racial minorities (39 Black, 2 Asian, 2 Hispanic, 3 other). MPs were younger at infusion (mean age 61.3 vs. 64.8 years; p = 0.012) and more likely to have impaired renal function (CrCl < 45 mL/min: 22% vs. 8.5%; p = 0.011). Other baseline disease characteristics were similar between groups. At 6 months, overall response rate (ORR) was 84% in MPs and 71% in WPs. Median progression-free survival was 16.1 months in MPs and 14.1 months in WPs, while median overall survival was 26.4 vs. 27.9 months, respectively; these differences were not statistically significant. Toxicity profiles were comparable overall; however, MPs experienced significantly higher rates of grade 4 neutropenia (41% vs. 21%; p = 0.01 ). In this real-world cohort, cilta-cel and ide-cel demonstrated similar efficacy and safety in MPs compared to WPs. These results support the use of BCMA-targeted CAR-T therapies across diverse populations and highlight the continued need to improve minority representation in clinical trials to ensure equitable access and outcomes in multiple myeloma care. Biological sciences/Cancer/Cancer therapy/Cancer immunotherapy Health sciences/Medical research/Translational research Figures Figure 1 Figure 2 Figure 3 Introduction Ciltacabtagene autoleucel (cilta-cel) and idecabtagene vicleucel (ide-cel) are B- cell maturation antigen (BCMA)-directed chimeric antigen receptor T-cell (CAR T) therapies that have become established treatments for heavily pretreated patients with relapsed/refractory multiple myeloma (RRMM) based on early, deep, and durable responses. 1 , 2 Supported by randomized phase III trials, CARTITUDE-4 (for cilta-cel) and KarMMA-3 (for ide-cel), both therapies have shown superior efficacy compared to standard-of-care treatments. 3 , 4 As a result, cilta-cel and ide-cel are increasingly being used earlier in the treatment course, often after the first or second relapse. Despite the clinical success of CAR T therapies, several logistical challenges persist, including the need for administration at specialized centers, intensive toxicity monitoring, and high out-of-pocket costs. These barriers, along with broader socioeconomic disparities, contribute to unequal access to CAR T therapy both within clinical trials and in general clinical practice. Historically, racial minority populations have been underrepresented in CAR T clinical trials. For example, in the CARTITUDE-4 trial, only 2.9% of participants were Black or African American, while the KarMMA-3 trial included just 7% Black patients and 3% Asian patients. 3 , 4 This underrepresentation could lead to disparities in outcomes and limit the widespread use of these therapies as they become more accessible. While few studies have examined the impact of race on the efficacy and toxicity of CAR T therapy, most have focused on non-Hodgkin lymphoma (NHL) and B-cell acute lymphoblastic leukemia (B-ALL), 5 – 7 with limited research in MM. One earlier study examined racial and ethnic differences in adverse events and outcomes among patients with RRMM treated with ide-cel in the standard-of-care setting. 8 It found that safety and response varied across various racial and ethnic subgroups, though no differences were observed in overall survival (OS) and progression-free survival (PFS). Given the scarcity of data from both real-world settings and clinical trials, this multicenter retrospective study compares the outcomes of ide-cel and cilta-cel in racial minority groups versus White patients, aiming to identify potential disparities and inform more inclusive and equitable treatment strategies for diverse patient populations. Methods Study Population This study pooled data from consecutive patients with RRMM who received either commercial cilta-cel or ide-cel between May 2022 and April 2024 at five participating centers: Levine Cancer Institute, Ohio State University, University of Kansas Cancer Center, University of Iowa, and Medical University of South Carolina. The study was approved by the relevant institutional review boards or ethics committees at each institution, and a waiver of informed consent was obtained for the retrospective record review. Demographic and clinical data were collected from electronic medical records. Baseline characteristics included age at CAR T therapy initiation, sex, race, Eastern Cooperative Oncology Group (ECOG) performance status, isotype, Revised International Staging System (R-ISS) stage, presence of high-risk features, extramedullary disease, prior lines of therapy, and refractory status to major drug classes. Race and ethnicity were self-reported. Treatment protocols for cytokine release syndrome (CRS) and immune-effector cell-associated neurotoxicity syndrome (ICANS), infectious disease prophylaxis, and the administration of growth factors support adhered to institutional guidelines. Statistical Methods For analysis, race/ethnicity was categorized into two broad groups: White and racial minority (which includes African American or Black, Asian, Hispanic or Latino, and other). Outcome measures, including CRS, ICANS, cytopenia, response rates, PFS, and OS, were compared between the two racial groups. Treatment response was assessed by treating investigators according to the International Myeloma Working Group criteria 9 at one, three-, and six-months post-CAR T infusion. Descriptive analyses were conducted using R Core Team (2024) software. Continuous variables were summarized as mean (min, max) and median (IQR), while dichotomous factors were reported by total numbers and frequencies. Fisher’s exact test was used for categorical comparisons, and the Wilcoxon rank-sum test was applied to assess differences in continuous variables between groups. To evaluate the relationship between predictor variables and time-to-event outcomes, univariate Cox proportional hazards analysis was performed, calculating hazard ratios (HRs) and 95% confidence intervals (CIs) while accounting for censored data. OS was calculated as the time from CAR T infusion to death or last contact, and PFS was calculated as the time from CAR T infusion to disease progression, death, or last contact. Kaplan-Meier survival curves and log-rank tests were used to examine OS and PFS by race and ethnicity. Univariate Cox proportional hazards models were then used to estimate HRs and 95% CIs for the association of race and ethnicity with OS and PFS, adjusting for baseline characteristics. Results Of the 223 patients who received either cilta-cel or ide-cel, 79% of patients were White, and 21% were racial minority. Among the 46 racial minority patients, 39 were Black or African American, 2 were Asian, 2 were Hispanic or Latino, and 3 identified as belonging to other racial or ethnic backgrounds. The distribution of baseline characteristics based on race/ethnicity is provided in Table 1 . Racial minority patients were younger at the time of CAR T infusion, with a median age of 61.5 (range, 41-83) years compared to 66 (range, 34-84) years in White patients (p = 0.012). Additionally, 43% of racial minority patients were male, compared to 59% of White patients (p = 0.054). An ECOG performance status of 2 or higher was observed in 18.8% of racial minority patients, compared to 7.5% of White patients (p = 0.0795). Renal dysfunction, defined as creatinine clearance below 45 mL/min, was more common in racial minority patients (22%) compared to White patients (8.5%; p = 0.011). Otherwise, the two groups were similar in terms of demographics, prior treatments, and disease characteristics, including the presence of high-risk cytogenetics. Notably, 41% of racial minority population and 24% of White patients would have been ineligible for KarMMa and or CARTITUDE clinical trials due to factors such as EF <45%, creatinine clearance <45%, plasma cell leukemia, concomitant AL amyloidosis, and previous anti-BCMA therapy ( Table 2 ). Among racial minority patients, 35% received cilta-cel and 65% received ide-cel, compared to 32% and 68%, respectively, among White patients. No statistically significant differences in overall response rate (ORR) or depth of response were noted at one, three and six months ( Figure 1 ). For instance, at six months, the overall response rate (ORR) was 84% among racial minority patients and 71% among White patients (p = 0.4), with a stringent complete response (sCR) observed in 17% versus 25%, complete response (CR) in 25% versus 17%, very good partial response (VGPR) in 25% versus 24%, partial response (PR) in 17% versus 4.7%, and progressive disease (PD) in 17% versus 26%, respectively. Data on minimal residual disease (MRD) was not available for a substantial proportion of patients in both groups ( Supplementary Table 1 ). No significant differences in toxicities and adverse events following CAR T therapy were observed between racial minority and White patients. The hematologic toxicities are shown in Figure 2 and Supplementary Table 2, and nonhematologic toxicities in Table 3 . The incidence of any grade CRS was 87% in racial minority patients and 80% in White patients (p= 0.30). Any grade ICANS within the first 30 days post-infusion occurred in 30% of racial minority patients compared to 18% of White patients (p = .065). Infections of any grade post CAR T infusion were reported in 30% of racial minority patients and 21% White patients (p = 0.20). The incidence of cytopenia was generally comparable between the groups, except for neutropenia at 60 days post-infusion. At that point, the median absolute neutrophil count (ANC) was 1.46 k/µL in racial minority patients, compared to 2.50 k/µL in White patients (p = 0.003; data not shown). A total of 8 patients (17%) in the minority group and 18 patients (10%) in the White group required a stem cell boost due to persistent cytopenia. The overall incidence of grade 4 neutropenia was significantly higher in the minority group (41%) compared to White patients (21%, p = 0.012). Similarly, the incidence of grade 3/4 thrombocytopenia was higher among minority patients (61%) than White patients (48%), although this difference did not reach statistical significance (p = 0.15) ( Supplementary Table 2 ). The median follow-up for the study population was 27.8 months (IQR 11 to N/A). Median follow-up was similar between the two groups: 26.4 months for racial minority and 27.8 months for White patients. The median PFS was 16.1 months [95% CI: 8.9, N/A] for racial minority patients, compared to 14.1 months [95% CI: 11.1,17.1] for White patients. Median OS was 26.4 months [95% CI: 16.5, N/A] in racial minority patients and 27.9 months [95% CI: 26.3, N/A] in White patients. No statistically significant difference was observed in PFS (p = 0.8079; HR 1.07, 95% CI: 0.64, 1.78) or OS (p = 0.4174; HR 0.78, 95% CI: 0.44, 1.39) between the two groups ( Figures 3 and 4 ). Even after adjusting for clinically relevant covariates, no differences in PFS were observed between the two groups ( Supplementary Table 3 ). Discussion Given the historical underrepresentation of minority populations in both early-phase clinical trials and pivotal registration studies, real-world data are essential for providing a more comprehensive understanding of treatment outcomes across diverse patient groups. This study evaluates the impact of race on patients with RRMM treated with Ide-cel and Cilta-cel, the two CAR T therapies currently approved for commercial use. Conducted across multiple academic centers, including those serving racially diverse catchment areas, racial minority patients were well-represented, comprising 21% of the overall study population. Among these, African American patients made up the largest subgroup, accounting for 39 of the 46 racial minority patients. Similarly, two other real-world studies of CAR T-cell therapy in RRMM reported Black patient representation at 17% and 15%, respectively. 8,10 While the proportion of African American and or Black patients in these studies exceeds that reported in clinical trials for ide-cel and cilta-cel, the absolute number remains modest, especially when considering the 2- to 3-fold higher incidence of multiple myeloma in African American population compared to the White population. Additionally, the comparatively younger age of minority patients receiving CAR T-cell therapy may reflect selection bias in referral patterns or access to care, rather than accurately representing the true median age at diagnosis among minority populations. These findings underscore the ongoing need for more inclusive and representative research efforts. Emerging data suggest that response to CAR T-cell therapy may be influenced by immune-related factors such as T-cell fitness and immune diversity. 11 The U.S. MM Immunotherapy Consortium study reported that non-Hispanic Black patients (n =36) had higher median levels of C-reactive protein and ferritin, were more likely to develop any grade of CRS, and had a higher best ORR compared to Hispanic (n = 22) and non-Hispanic White patients (n = 149). 8 In contrast, our study did not observe significant differences in incidence of CRS or ICANS between racial minority and white patients, though data on inflammatory marker data were not collected. Similarly, no significant differences were seen in ORR, including VGPR or CR at predefined time points. We also did not observe any significant differences in PFS or OS by race or ethnicity following CAR T therapy. These findings align with the consortium study, which reported no racial or ethnic disparities in PFS or OS despite observed differences in CRS and ORR. 8 Similarly, other studies of CAR T-cell therapy in NHL and ALL have shown comparable overall survival across racial groups. 5-7 Notably, this pattern extends to autologous stem cell transplantation, where emerging evidence suggests that, after adjusting for sociodemographic confounders, Black patients may experience survival outcomes equal to or better than those of White patients. 12,13 These findings suggest that when access to care is equitable, racial disparities in treatment outcomes can be significantly reduced. Consequently, race or ethnicity should not influence clinical decision-making or patient counseling regarding the risks or expected outcomes of CAR T therapy. In our study, 41% of the minority patients and 24% of the White patients (p-value = 0.017) would not have met the eligibility criteria for the KarMMa or CARTITUDE clinical trials that led to the FDA approval of ide-cel and cilta-cel. This figure is likely an underestimate, as baseline ANC and platelet counts at the time of lymphodepleting chemotherapy were not collected. The U.S. MM Immunotherapy Consortium study similarly found that 75% of patients would not have been eligible for the KarMMa trial, underscoring the restrictive nature of current trial criteria. 8 One key exclusion factor among clinical trials was renal dysfunction, defined as a creatinine clearance <45 mL/min, which was more common among racial minority patients (22%) in our cohort compared to White patients (8.5%; p = 0.011). These findings highlight how current trial eligibility criteria, while intended for safety, may inadvertently exclude a significant proportion of minority patients with comorbidities and limit the applicability of trial results to real-world settings. Revisiting and potentially broadening these criteria through more flexible trial designs is necessary to ensure equitable access to emerging therapies and to improve the representation of historically underrepresented groups in clinical research. A key limitation of this study is that it includes only patients with RRMM who were referred to academic centers and received CAR T therapy, without accounting for those who may have faced physical, socioeconomic, or systemic barriers to access. CAR T therapy remains largely confined to specialized centers, and access is influenced by geography, healthcare infrastructure, referral patterns, insurance coverage, and stringent eligibility criteria. 14,15 As such, our cohort may not fully represent the broader RRMM population, especially those facing access challenges. Moreover, the absence of data on insurance type, treatment denials, and distance from treatment centers limits our ability to assess how these factors influence disparities in access and outcomes. Previous studies have shown that socioeconomic stratum and insurance coverage are critical determinants of access to CAR T therapy and contribute to racial and ethnic disparities in outcomes. 6,14 As with other observational studies, our analysis is also subject to missing data, as data collection was site-dependent and aligned with routine clinical practice. Finally, most patients in our study had heavily pretreated RRMM at the time of referral, and therefore, survival outcomes may not be generalizable to patients treated earlier in their disease course, which is particularly relevant as CAR T-cell therapy is increasingly used in earlier lines of treatment. In conclusion, racial minority patients achieved similar OS, PFS and ORR compared to White patients following treatment with cilta-cel or ide-cel for RRMM. Toxicity profiles were also comparable between the groups. These findings suggest that among patients who can access CAR T therapy, real-world efficacy and safety outcomes are consistent across racial groups. Ongoing evaluation of CAR T therapy in diverse populations is essential to ensure equitable improvements in outcomes for all individuals with RRMM. Future prospective trials should prioritize improved representation of racial and ethnic minority groups to better inform treatment strategies and reduce disparities in access and outcomes. Declarations Acknowledgments The authors gratefully acknowledge the support of the U.S. Myeloma Innovations and Research Collaborative (USMIRC) for its contributions to this work, including assistance with study design, critical review of the manuscript, and administrative coordination. Author Contributions MB and SA wrote the first draft of the manuscript. Data collection: AH, AV, HS, DC, CS, KG, MUM, ZM, AK. Statistical analysis: SA. All authors participated in reviewing and approving this paper. Conflict of Interest (COI) MB: Consulting or Advisory Role: Caribou Biosciences; Research Funding: Janssen (Inst), Amgen (Inst), Bristol Myers Squibb/ Celgene (Inst), Takeda (Inst), Abbvie (Inst), Caribou Biosciences (Inst), and The Binding Site (Inst). MUM: Research Funding: Iovance Biotherapeutics (Inst). ZM: Leadership: Hematology Oncology Pharmacists Association; Honoraria: Bristol Myers Squibb Foundation, Kite/Gilead, Genentech, Pfizer, and Sanofi. JPM: Honoraria: Kite, a Gilead company, AlloVir, Nektar, Sana Biotechnology, Bristol Myers Squibb/Sanofi, Novartis, crispr therapeutics, CARGO Therapeutics, Autolus, Legend Biotech; Consulting or Advisory Role: Kite, a Gilead company, Juno Therapeutics, Allovir, Magenta Therapeutics, EcoR1 Capital, crispr therapeutics, Fosun Kite Biotechnology Co, Ltd, Sanofi US Services, Inc, Novartis, Nektar, Sana Biotechnology, Inc; Speakers’ Bureau: Kite/Gilead; Research Funding: Novartis (Inst), Fresenius Biotech (Inst), Astellas Pharma (Inst), Bellicum Pharmaceuticals (Inst), Novartis (Inst), Gamida Cell (Inst), Pluristem Therapeutics (Inst), Kite, a Gilead company (Inst), AlloVir (Inst). PV: Consultancy or Advisory Role: AbbVie, AstraZeneca, BMS, Karyopharm, Lava Therapeutics, Sanofi, Regeneron, Janssen, GSK; Research Funding: AbbVie, GSK, Janssen, Regeneron. A-OA: Research Funding: Celgene (Inst), Seagen (Inst), AbbVie (Inst), Bristol Myers Squibb/Medarex (Inst), Sanofi (Inst), GlaxoSmithKline (Inst). Patents, Royalties, Other Intellectual Property: PSA vaccine patent. NA: Consulting or Advisory Role: Kite/Gilead, BMS, Legend Biotech, Invivyd; Research Funding: Kite/Gilead (Inst). SA: Leadership ACCRU; Consulting or Advisory Role: Pfizer, Sanofi: Research Funding: GlaxoSmithKline, Amgen, Karyopharm Therapeutics, Janssen Oncology (Inst), Celgene/Bristol Myers Squibb (Inst); Honoraria: Janssen, GSK, Sanofi. AH, AV, AN, ES, HS, DC, CS, KG and AMK: These authors declare no competing financial interests. Data Availability Statement The datasets generated during and/or analyzed during the current study are not publicly available due to HIPPA but are available from the corresponding author on reasonable request. References Berdeja JG, Madduri D, Usmani SZ, et al: Ciltacabtagene autoleucel, a B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy in patients with relapsed or refractory multiple myeloma (CARTITUDE-1): a phase 1b/2 open-label study. Lancet 398:314-324, 2021 Munshi NC, Hege K, San-Miguel J: Idecabtagene Vicleucel in Relapsed Myeloma. Reply. N Engl J Med 384:2357-2358, 2021 San-Miguel J, Dhakal B, Yong K, et al: Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma. N Engl J Med 389:335-347, 2023 Rodriguez-Otero P, Ailawadhi S, Arnulf B, et al: Ide-cel or Standard Regimens in Relapsed and Refractory Multiple Myeloma. N Engl J Med 388:1002-1014, 2023 Faruqi AJ, Ligon JA, Borgman P, et al: The impact of race, ethnicity, and obesity on CAR T-cell therapy outcomes. Blood Adv 6:6040-6050, 2022 Karmali R, Machhi R, Epperla N, et al: Impact of race and social determinants of health on outcomes in patients with aggressive B-cell NHL treated with CAR-T therapy. Blood Adv 8:2592-2599, 2024 Locke FL, Siddiqi T, Jacobson CA, et al: Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity. Blood 143:2722-2734, 2024 Peres LC, Oswald LB, Dillard CM, et al: Racial and ethnic differences in clinical outcomes among patients with multiple myeloma treated with CAR T-cell therapy. Blood Adv 8:251-259, 2024 Kumar S, Paiva B, Anderson KC, et al: International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 17:e328-e346, 2016 Wesson W, Dima D, Suleman N, et al: Timing of Toxicities and Non-Relapse Mortality Following CAR T Therapy in Myeloma. Transplant Cell Ther 30:876-884, 2024 Dhodapkar KM, Cohen AD, Kaushal A, et al: Changes in Bone Marrow Tumor and Immune Cells Correlate with Durability of Remissions Following BCMA CAR T Therapy in Myeloma. Blood Cancer Discov 3:490-501, 2022 Dong J, Garacci Z, Buradagunta CS, et al: Black patients with multiple myeloma have better survival than white patients when treated equally: a matched cohort study. Blood Cancer J 12:34, 2022 Mikhael J, Cichewicz A, Mearns ES, et al: Overall Survival in Patients With Multiple Myeloma in the U.S.: A Systematic Literature Review of Racial Disparities. Clin Lymphoma Myeloma Leuk 24:e1-e12, 2024 Ahmed N, Shahzad M, Shippey E, et al: Socioeconomic and Racial Disparity in Chimeric Antigen Receptor T Cell Therapy Access. Transplant Cell Ther 28:358-364, 2022 Snyder S, Chung KC, Jun MP, et al: Access to Chimeric Antigen Receptor T Cell Therapy for Diffuse Large B Cell Lymphoma. Adv Ther 38:4659-4674, 2021 Tables Table 1. Baseline clinical and disease characteristics Characteristic Minority, N = 46 a White, N = 177 a p-value b Age (median, years) 61.5 (41.0-83.0) 66.0 (34.0-84.0) 0.012 Male 20 (43%) 105 (59%) 0.054 ECOG 0.033 0 2 (4.4%) 22 (14%) 1 35 (78%) 125 (79%) 2 7 (16%) 12 (7.5%) 3 1 (2.2%) 0 (0%) Heavy Isotype 0.8 IgA 7 (15%) 35 (20%) IgG 29 (63%) 104 (59%) Light chain disease 10 (22%) 37 (21%) Light Chain 0.6 Kappa 26 (57%) 109 (62%) Lambda 20 (43%) 67 (38%) R-ISS stage 0.082 1 5 (16%) 34 (24%) 2 12 (39%) 70 (50%) 3 14 (45%) 35 (25%) Unknown 15 38 High-risk cytogenetics Deletion 17p 7 (15%) 38 (21%) 0.3 t(4;14) 4 (8.7%) 18 (10%) >0.9 t(14;16) 2 (4.3%) 8 (4.5%) >0.9 Plasma cell leukemia 1 (2.2%) 3 (1.7%) >0.9 EMD 16 (35%) 67 (38%) 0.7 CrCl <45 10 (22%) 15 (8.5%) 0.011 Prior transplant 37 (80%) 148 (84%) 0.6 Prior lines of therapy 5.0 (0.0-12.0) 6.0 (1.0-13.0) 0.5 Refractory Status Bortezomib refractory 28 (61%) 95 (54%) 0.6 Carfilzomib refractory 33 (72%) 125 (71%) 0.4 Lenalidomide refractory 36 (78%) 137 (77%) 0.5 Pomalidomide refractory 38 (83%) 131 (74%) 0.5 Anti-CD38 refractory 42 (91%) 163 (92.1%) 0.6 Previous anti-BCMA exposed 7 (15%) 22 (12%) 0.6 Product 0.7 Cilta-Cel 16 (35%) 57 (32%) Ide-Cel 30 (65%) 120 (68%) Table 2. Clinical trial eligibility by race as based on ejection fraction, creatinine clearance, presence of plasma cell leukemia, prior BCMA exposure, and AL amyloidosis Characteristic Race p-value Minority N = 46 White N = 177 Total number of Ineligible patients 19 (41%) 42 (24%) 0.017 EF < 45% 2 (4.3%) 2 (1.1%) 0.2 CrCl 0.9 Concomitant AL Amyloidosis 1 (2.2%) 5 (2.8%) >0.9 Previous anti-BCMA 7 (15%) 22 (12%) 0.6 Note: Values are presented as n (%). p-values are from Pearson’s Chi-squared test. Table 3. Summary of non-hematologic toxicities by race Characteristic Minority (N = 46), n(%) White N = 177, n(%) p-value* CRS any grade 40 (87%) 142 (80%) 0.3 Max CRS 0.7 0 6 (13%) 35 (20%) 1 28 (61%) 101 (57%) 2 12 (26%) 39 (22%) 3 0 (0%) 2 (1.1%) ICANS any grade 14 (30%) 32 (18%) 0.065 Max ICANS 0.1 0 32 (70%) 141 (80%) 1 6 (13%) 20 (11%) 2 4 (8.7%) 13 (7.3%) 3 2 (4.3%) 1 (0.6%) 4 1 (2.2%) 2 (1.1%) 5 1 (2.2%) 0 (0%) Infection of any grade 14 (30%) 37 (21%) 0.2 Hospitalization (days) 11 (8, 17) 10 (7, 15) 0.13 Parkinsonian 0 (0%) 1 (0.6%) >0.9 Note: Hospitalization duration is reported as median (interquartile range). *P-values were calculated using Pearson's Chi-squared test; Fisher's exact test; and Wilcoxon rank sum test. Additional Declarations Yes there is potential conflict of interest. Supplementary Files SupplementaryTable1.docx Cite Share Download PDF Status: Published Journal Publication published 21 Nov, 2025 Read the published version in Blood Cancer Journal → Version 1 posted Editorial decision: revise 28 Aug, 2025 Review # 2 received at journal 18 Aug, 2025 Review # 1 received at journal 11 Aug, 2025 Reviewer # 2 agreed at journal 03 Aug, 2025 Reviewer # 1 agreed at journal 28 Jul, 2025 Reviewers invited by journal 28 Jul, 2025 Editor assigned by journal 28 Jul, 2025 Submission checks completed at journal 28 Jul, 2025 First submitted to journal 25 Jul, 2025 Unknown event 25 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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IA","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"vegel","suffix":""},{"id":492077686,"identity":"c636b0c4-3e4b-46a4-959f-40eb5175c012","order_by":4,"name":"Ami Ndiaye","email":"","orcid":"","institution":"Levine Cancer Institute / Atrium Health","correspondingAuthor":false,"prefix":"","firstName":"Ami","middleName":"","lastName":"Ndiaye","suffix":""},{"id":492077687,"identity":"ff988e74-90c1-40c2-b3f3-d8c0c1f1cbc7","order_by":5,"name":"Emily Struble","email":"","orcid":"","institution":"Division of Hematology, Oncology, and Blood \u0026 Marrow Transplantation, University of Iowa","correspondingAuthor":false,"prefix":"","firstName":"Emily","middleName":"","lastName":"Struble","suffix":""},{"id":492077688,"identity":"cded65c6-983c-428d-af45-322448030406","order_by":6,"name":"Darryl Chang","email":"","orcid":"","institution":"Advocate Health, Wake Forest University School of Medicine, Charlotte, NC","correspondingAuthor":false,"prefix":"","firstName":"Darryl","middleName":"","lastName":"Chang","suffix":""},{"id":492077689,"identity":"99c68dc2-cd53-498b-a11e-e56b07924429","order_by":7,"name":"Christopher Strouse","email":"","orcid":"","institution":"University of Iowa","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"","lastName":"Strouse","suffix":""},{"id":492077690,"identity":"804df8c8-bbe0-4522-8733-e2d0c4fe4df1","order_by":8,"name":"Kimberly Green","email":"","orcid":"","institution":"MUSC","correspondingAuthor":false,"prefix":"","firstName":"Kimberly","middleName":"","lastName":"Green","suffix":""},{"id":492077691,"identity":"7a2e3d59-8472-499b-8c3f-d889322da09b","order_by":9,"name":"Muhammad Umair Mushtaq","email":"","orcid":"","institution":"University of Kansas Medical School","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Umair","lastName":"Mushtaq","suffix":""},{"id":492077692,"identity":"592372eb-3fac-42b3-ad88-a68e65d7404f","order_by":10,"name":"Zahra Mahmoudjafari","email":"","orcid":"https://orcid.org/0000-0002-3168-2521","institution":"Division of Hematologic Malignancies \u0026 Cellular Therapeutics, University of Kansas Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Mahmoudjafari","suffix":""},{"id":492077693,"identity":"57c928a1-e6d6-40e8-a97a-54cf4ab6ed5a","order_by":11,"name":"Joseph McGuirk","email":"","orcid":"https://orcid.org/0000-0002-0539-4796","institution":"University of Kansas Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"McGuirk","suffix":""},{"id":492077694,"identity":"034cddbb-c64d-4b87-8836-72f55e129d41","order_by":12,"name":"Peter Voorhees","email":"","orcid":"https://orcid.org/0000-0003-1661-718X","institution":"Levine Cancer Institute, Atrium Health","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Voorhees","suffix":""},{"id":492077695,"identity":"9fb33a93-7373-49a1-aa25-1039853e27e3","order_by":13,"name":"Abdullah Khan","email":"","orcid":"https://orcid.org/0000-0003-2166-2583","institution":"The Ohio State University Comprehensive Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Abdullah","middleName":"","lastName":"Khan","suffix":""},{"id":492077696,"identity":"72c2338c-46b0-479b-8456-5c1253813725","order_by":14,"name":"Al-Ola Abdallah","email":"","orcid":"","institution":"University of Kansas Cancer Center","correspondingAuthor":false,"prefix":"","firstName":"Al-Ola","middleName":"","lastName":"Abdallah","suffix":""},{"id":492077697,"identity":"f97af2b4-2722-42ba-9058-29e0808bf025","order_by":15,"name":"Nausheen Ahmed","email":"","orcid":"https://orcid.org/0000-0003-4336-4982","institution":"University of Kansas Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Nausheen","middleName":"","lastName":"Ahmed","suffix":""},{"id":492077698,"identity":"b0658b59-cb03-4116-9194-0bae703e586c","order_by":16,"name":"Shebli Atrash","email":"","orcid":"https://orcid.org/0000-0003-4547-7534","institution":"Atrium Health / Levine Cancer Institute, Wake Forest University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shebli","middleName":"","lastName":"Atrash","suffix":""}],"badges":[],"createdAt":"2025-07-24 19:30:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7208369/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7208369/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41408-025-01419-1","type":"published","date":"2025-11-21T05:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88002196,"identity":"9d508897-9112-4de0-b9f1-fb79eb958bee","added_by":"auto","created_at":"2025-07-31 10:26:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":91013,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBar plot of best response by race at 30 days, 3 months, 6 months, and 1 year post-CAR T therapy\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7208369/v1/92fbe5d028aedd6925e137f6.png"},{"id":88002195,"identity":"62a4591e-8abb-4a45-878a-1132c477f947","added_by":"auto","created_at":"2025-07-31 10:26:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":70530,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBar plot of maximum grade of hematologic toxicity by race\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7208369/v1/ee6857e65b06637ddc2d66ea.png"},{"id":88002198,"identity":"b54c88c1-a6c5-4487-b107-89e2c88096dd","added_by":"auto","created_at":"2025-07-31 10:26:35","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":183737,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigures 3 and 4. Kaplan-Meier curves depicting progression-free survival (PFS) and overall survival (OS) by race.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePanel 1 shows PFS, and Panel 2 shows OS for minority and White patient groups\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7208369/v1/5425fa2165d0db396d3b6060.png"},{"id":96514088,"identity":"8d47153a-4147-4614-a135-281b17da340d","added_by":"auto","created_at":"2025-11-22 08:13:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1273271,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7208369/v1/cc1cf2b3-884b-4da3-9d4a-3885637661a2.pdf"},{"id":88002197,"identity":"c7558ca2-415a-437f-9ef3-501fca4171f2","added_by":"auto","created_at":"2025-07-31 10:26:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16444,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7208369/v1/0c826a8ddfe1d2454a4630e2.docx"}],"financialInterests":"\u003cb\u003eYes\u003c/b\u003e there is potential conflict of interest.","formattedTitle":"Outcomes of CAR T-Cell Therapy in Relapsed/Refractory Multiple Myeloma by Race: A Multicenter Real-World Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCiltacabtagene autoleucel (cilta-cel) and idecabtagene vicleucel (ide-cel) are B- cell maturation antigen (BCMA)-directed chimeric antigen receptor T-cell (CAR T) therapies that have become established treatments for heavily pretreated patients with relapsed/refractory multiple myeloma (RRMM) based on early, deep, and durable responses.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Supported by randomized phase III trials, CARTITUDE-4 (for cilta-cel) and KarMMA-3 (for ide-cel), both therapies have shown superior efficacy compared to standard-of-care treatments.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e As a result, cilta-cel and ide-cel are increasingly being used earlier in the treatment course, often after the first or second relapse.\u003c/p\u003e\u003cp\u003eDespite the clinical success of CAR T therapies, several logistical challenges persist, including the need for administration at specialized centers, intensive toxicity monitoring, and high out-of-pocket costs. These barriers, along with broader socioeconomic disparities, contribute to unequal access to CAR T therapy both within clinical trials and in general clinical practice. Historically, racial minority populations have been underrepresented in CAR T clinical trials. For example, in the CARTITUDE-4 trial, only 2.9% of participants were Black or African American, while the KarMMA-3 trial included just 7% Black patients and 3% Asian patients.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e This underrepresentation could lead to disparities in outcomes and limit the widespread use of these therapies as they become more accessible.\u003c/p\u003e\u003cp\u003eWhile few studies have examined the impact of race on the efficacy and toxicity of CAR T therapy, most have focused on non-Hodgkin lymphoma (NHL) and B-cell acute lymphoblastic leukemia (B-ALL), \u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e with limited research in MM. One earlier study examined racial and ethnic differences in adverse events and outcomes among patients with RRMM treated with ide-cel in the standard-of-care setting.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e It found that safety and response varied across various racial and ethnic subgroups, though no differences were observed in overall survival (OS) and progression-free survival (PFS).\u003c/p\u003e\u003cp\u003eGiven the scarcity of data from both real-world settings and clinical trials, this multicenter retrospective study compares the outcomes of ide-cel and cilta-cel in racial minority groups versus White patients, aiming to identify potential disparities and inform more inclusive and equitable treatment strategies for diverse patient populations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy Population\u003c/em\u003e\u003c/p\u003e\u003cp\u003e This study pooled data from consecutive patients with RRMM who received either commercial cilta-cel or ide-cel between May 2022 and April 2024 at five participating centers: Levine Cancer Institute, Ohio State University, University of Kansas Cancer Center, University of Iowa, and Medical University of South Carolina. The study was approved by the relevant institutional review boards or ethics committees at each institution, and a waiver of informed consent was obtained for the retrospective record review.\u003c/p\u003e\u003cp\u003eDemographic and clinical data were collected from electronic medical records. Baseline characteristics included age at CAR T therapy initiation, sex, race, Eastern Cooperative Oncology Group (ECOG) performance status, isotype, Revised International Staging System (R-ISS) stage, presence of high-risk features, extramedullary disease, prior lines of therapy, and refractory status to major drug classes. Race and ethnicity were self-reported. Treatment protocols for cytokine release syndrome (CRS) and immune-effector cell-associated neurotoxicity syndrome (ICANS), infectious disease prophylaxis, and the administration of growth factors support adhered to institutional guidelines.\u003c/p\u003e\u003cp\u003e\u003cem\u003eStatistical Methods\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFor analysis, race/ethnicity was categorized into two broad groups: White and racial minority (which includes African American or Black, Asian, Hispanic or Latino, and other). Outcome measures, including CRS, ICANS, cytopenia, response rates, PFS, and OS, were compared between the two racial groups. Treatment response was assessed by treating investigators according to the International Myeloma Working Group criteria\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e at one, three-, and six-months post-CAR T infusion. Descriptive analyses were conducted using R Core Team (2024) software. Continuous variables were summarized as mean (min, max) and median (IQR), while dichotomous factors were reported by total numbers and frequencies. Fisher’s exact test was used for categorical comparisons, and the Wilcoxon rank-sum test was applied to assess differences in continuous variables between groups.\u003c/p\u003e\u003cp\u003eTo evaluate the relationship between predictor variables and time-to-event outcomes, univariate Cox proportional hazards analysis was performed, calculating hazard ratios (HRs) and 95% confidence intervals (CIs) while accounting for censored data. OS was calculated as the time from CAR T infusion to death or last contact, and PFS was calculated as the time from CAR T infusion to disease progression, death, or last contact. Kaplan-Meier survival curves and log-rank tests were used to examine OS and PFS by race and ethnicity. Univariate Cox proportional hazards models were then used to estimate HRs and 95% CIs for the association of race and ethnicity with OS and PFS, adjusting for baseline characteristics.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 223 patients who received either cilta-cel or ide-cel, 79% of patients were White, and 21% were racial minority. Among the 46 racial minority patients, 39 were Black or African American, 2 were Asian, 2 were Hispanic or Latino, and 3 identified as belonging to other racial or ethnic backgrounds. The distribution of baseline characteristics based on race/ethnicity is provided in \u003cstrong\u003eTable 1\u003c/strong\u003e. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRacial minority patients were younger at the time of CAR T infusion, with a median age of 61.5 (range, 41-83) years compared to 66 (range, 34-84) years in White patients (p = 0.012). Additionally, 43% of racial minority patients were male, compared to 59% of White patients (p = 0.054). An ECOG performance status of 2 or higher was observed in 18.8% of racial minority patients, compared to 7.5% of White patients (p = 0.0795). Renal dysfunction, defined as creatinine clearance below 45 mL/min, was more common in racial minority patients (22%) compared to White patients (8.5%; p = 0.011). Otherwise, the two groups were similar in terms of demographics, prior treatments, and disease characteristics, including the presence of high-risk cytogenetics. Notably,\u0026nbsp;41% of racial minority population and 24% of White patients would have been ineligible for KarMMa and or CARTITUDE clinical trials due to factors such as EF \u0026lt;45%, creatinine clearance \u0026lt;45%, plasma cell leukemia, concomitant AL amyloidosis, and previous anti-BCMA therapy (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong racial minority patients, 35% received cilta-cel and 65% received ide-cel, compared to 32% and 68%, respectively, among White patients. \u0026nbsp;No statistically significant differences in overall response rate (ORR) or depth of response were noted at one, three and six months (\u003cstrong\u003eFigure 1\u003c/strong\u003e). For instance, at six months, the overall response rate (ORR) was 84% among racial minority patients and 71% among White patients (p = 0.4), with a stringent complete response (sCR) observed in 17% versus 25%, complete response (CR) in 25% versus 17%, very good partial response (VGPR) in 25% versus 24%, partial response (PR) in 17% versus 4.7%, and progressive disease (PD) in 17% versus 26%, respectively. Data on minimal residual disease (MRD) was not available for a substantial proportion of patients in both groups (\u003cstrong\u003eSupplementary Table 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eNo significant differences in toxicities and adverse events following CAR T therapy were observed between racial minority and White patients. The hematologic toxicities are shown in \u003cstrong\u003eFigure 2\u0026nbsp;\u003c/strong\u003eand \u003cstrong\u003eSupplementary Table 2,\u003c/strong\u003e and nonhematologic toxicities in \u003cstrong\u003eTable 3\u003c/strong\u003e. The incidence of any grade CRS was 87% in racial minority patients and 80% in White patients (p= 0.30). \u0026nbsp;Any grade ICANS within the first 30 days post-infusion occurred in 30% of racial minority patients compared to 18% of White patients (p = .065). Infections of any grade post CAR T infusion were reported in 30% of racial minority patients and 21% White patients (p = 0.20). The incidence of cytopenia was generally comparable between the groups, except for neutropenia at 60 days post-infusion. At that point, the median absolute neutrophil count (ANC) was 1.46 k/\u0026micro;L in racial minority patients, compared to 2.50 k/\u0026micro;L in White patients (p = 0.003; data not shown). A total of 8 patients (17%) in the minority group and 18 patients (10%) in the White group required a stem cell boost due to persistent cytopenia. The overall incidence of grade 4 neutropenia was significantly higher in the minority group (41%) compared to White patients (21%, p = 0.012). Similarly, the incidence of grade 3/4 thrombocytopenia was higher among minority patients (61%) than White patients (48%), although this difference did not reach statistical significance (p = 0.15) (\u003cstrong\u003eSupplementary Table 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThe median follow-up for the study population was 27.8 months (IQR 11 to N/A). Median follow-up was similar between the two groups: 26.4 months for racial minority and 27.8 months for White patients. The median PFS was 16.1 months [95% CI: 8.9, N/A] for racial minority patients, compared to 14.1 months [95% CI: 11.1,17.1] for White patients. Median OS was 26.4 months [95% CI: 16.5, N/A] in racial minority patients and 27.9 months [95% CI: 26.3, N/A] in White patients. No statistically significant difference was observed in PFS (p = 0.8079; HR 1.07, 95% CI: 0.64, 1.78) or OS (p = 0.4174; HR 0.78, 95% CI: 0.44, 1.39) between the two groups (\u003cstrong\u003eFigures 3 and 4\u003c/strong\u003e). Even after adjusting for clinically relevant covariates, no differences in PFS were observed between the two groups (\u003cstrong\u003eSupplementary Table 3\u003c/strong\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eGiven the historical underrepresentation of minority populations in both early-phase clinical trials and pivotal registration studies, real-world data are essential for providing a more comprehensive understanding of treatment outcomes across diverse patient groups. This study evaluates the impact of race on patients with RRMM treated with Ide-cel and Cilta-cel, the two CAR T therapies currently approved for commercial use. Conducted across multiple academic centers, including those serving racially diverse catchment areas, racial minority patients were well-represented, comprising 21% of the overall study population. Among these, African American patients made up the largest subgroup, accounting for 39 of the 46 racial minority patients. Similarly, two other real-world studies of CAR T-cell therapy in RRMM reported Black patient representation at 17% and 15%, respectively.\u003csup\u003e8,10\u003c/sup\u003e\u0026nbsp; While the proportion of African American and or Black patients in these studies exceeds that reported in clinical trials for ide-cel and cilta-cel, the absolute number remains modest, especially when considering the 2- to 3-fold higher incidence of multiple myeloma in African American population compared to the White population. Additionally, the comparatively younger age of minority patients receiving CAR T-cell therapy may reflect selection bias in referral patterns or access to care, rather than accurately representing the true median age at diagnosis among minority populations. These findings underscore the ongoing need for more inclusive and representative research efforts.\u003c/p\u003e\n\u003cp\u003eEmerging data suggest that response to CAR T-cell therapy may be influenced by immune-related factors such as T-cell fitness and immune diversity.\u003csup\u003e11\u003c/sup\u003e The U.S. MM Immunotherapy Consortium study reported that non-Hispanic Black patients (n =36) had higher median levels of C-reactive protein and ferritin, were more likely to develop any grade of CRS, and had a higher best ORR compared to Hispanic (n = 22) and non-Hispanic White patients (n = 149).\u003csup\u003e8\u003c/sup\u003e\u0026nbsp; In contrast, our study did not observe significant differences in incidence of CRS or ICANS between racial minority and white patients, though data on inflammatory marker data were not collected. Similarly, no significant differences were seen in ORR, including VGPR or CR at predefined time points.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe also did not observe any significant differences in PFS or OS by race or ethnicity following CAR T therapy. These findings align with the consortium study, which reported no racial or ethnic disparities in PFS or OS despite observed differences in CRS and ORR.\u003csup\u003e8\u003c/sup\u003e Similarly, other studies of CAR T-cell therapy in NHL and ALL have shown comparable overall survival across racial groups.\u003csup\u003e5-7\u003c/sup\u003e Notably, this pattern extends to autologous stem cell transplantation, where emerging evidence suggests that, after adjusting for sociodemographic confounders, Black patients may experience survival outcomes equal to or better than those of White patients.\u003csup\u003e12,13\u003c/sup\u003e These findings suggest that when access to care is equitable, racial disparities in treatment outcomes can be significantly reduced. Consequently, race or ethnicity should not influence clinical decision-making or patient counseling regarding the risks or expected outcomes of CAR T therapy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn our study, 41% of the minority patients and 24% of the White patients (p-value = 0.017) would not have met the eligibility criteria for the KarMMa or CARTITUDE clinical trials that led to the FDA approval of ide-cel and cilta-cel. This figure is likely an underestimate, as baseline ANC and platelet counts at the time of lymphodepleting chemotherapy were not collected. \u0026nbsp;The U.S. MM Immunotherapy Consortium study similarly found that\u0026nbsp;75% of patients would not have been eligible for the KarMMa trial, underscoring the restrictive nature of current trial criteria.\u003csup\u003e8\u003c/sup\u003e One key exclusion factor among clinical trials was renal dysfunction, defined as a creatinine clearance \u0026lt;45 mL/min, which was more common among racial minority patients (22%) in our cohort compared to White patients (8.5%; p = 0.011). These findings highlight how current trial eligibility criteria, while intended for safety, may inadvertently exclude a significant proportion of minority patients with comorbidities and limit the applicability of trial results to real-world settings. Revisiting and potentially broadening these criteria through more flexible trial designs is necessary to ensure equitable access to emerging therapies and to improve the representation of historically underrepresented groups in clinical research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA key limitation of this study is that it includes only patients with RRMM who were referred to academic centers and received CAR T therapy, without accounting for those who may have faced physical, socioeconomic, or systemic barriers to access. CAR T therapy remains largely confined to specialized centers, and access is influenced by geography, healthcare infrastructure, referral patterns, insurance coverage, and stringent eligibility criteria.\u003csup\u003e14,15\u003c/sup\u003e\u0026nbsp; As such, our cohort may not fully represent the broader RRMM population, especially those facing access challenges.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, the absence of data on insurance type, treatment denials, and distance from treatment centers limits our ability to assess how these factors influence disparities in access and outcomes. Previous studies have shown that socioeconomic stratum and insurance coverage are critical determinants of access to CAR T therapy and contribute to racial and ethnic disparities in outcomes.\u003csup\u003e6,14\u003c/sup\u003e As with other observational studies, our analysis is also subject to missing data, as data collection was site-dependent and aligned with routine clinical practice. Finally, most patients in our study had heavily pretreated RRMM at the time of referral, and therefore, survival outcomes may not be generalizable to patients treated earlier in their disease course, which is particularly relevant as CAR T-cell therapy is increasingly used in earlier lines of treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, racial minority patients achieved similar OS, PFS and ORR compared to White patients following treatment with cilta-cel or ide-cel for RRMM. Toxicity profiles were also comparable between the groups. These findings suggest that among patients who can access CAR T therapy, real-world efficacy and safety outcomes are consistent across racial groups. Ongoing evaluation of CAR T therapy in diverse populations is essential to ensure equitable improvements in outcomes for all individuals with RRMM. Future prospective trials should prioritize improved representation of racial and ethnic minority groups to better inform treatment strategies and reduce disparities in access and outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the support of the U.S. Myeloma Innovations and Research Collaborative (USMIRC) for its contributions to this work, including assistance with study design, critical review of the manuscript, and administrative coordination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMB and SA wrote the first draft of the manuscript. Data collection: AH, AV, HS, DC, CS, KG, \u0026nbsp;MUM, ZM, AK. Statistical analysis: SA. All authors participated in reviewing and approving this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest (COI)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMB: Consulting or Advisory Role: Caribou Biosciences; Research Funding: Janssen (Inst), Amgen (Inst), Bristol Myers Squibb/ Celgene (Inst), Takeda (Inst), Abbvie (Inst), Caribou Biosciences (Inst), and The Binding Site (Inst).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMUM: Research Funding: Iovance Biotherapeutics (Inst).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;ZM: Leadership: Hematology Oncology Pharmacists Association; Honoraria: Bristol Myers Squibb Foundation, Kite/Gilead, Genentech, Pfizer, and Sanofi.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;JPM: Honoraria: Kite, a Gilead company, AlloVir, Nektar, Sana Biotechnology, Bristol Myers Squibb/Sanofi, Novartis, crispr therapeutics, CARGO Therapeutics, Autolus, Legend Biotech; Consulting or Advisory Role: Kite, a Gilead company, Juno Therapeutics, Allovir, Magenta Therapeutics, EcoR1 Capital, crispr therapeutics, Fosun Kite Biotechnology Co, Ltd, Sanofi US Services, Inc, Novartis, Nektar, Sana Biotechnology, Inc; Speakers’ Bureau: Kite/Gilead; Research Funding: Novartis (Inst), Fresenius Biotech (Inst), Astellas Pharma (Inst), Bellicum Pharmaceuticals (Inst), Novartis (Inst), Gamida Cell (Inst), Pluristem Therapeutics (Inst), Kite, a Gilead company (Inst), AlloVir (Inst).\u003c/p\u003e\n\u003cp\u003ePV: Consultancy or Advisory Role: AbbVie, AstraZeneca, BMS, Karyopharm, Lava Therapeutics, Sanofi, Regeneron, Janssen, GSK; Research Funding: AbbVie, GSK, Janssen, Regeneron. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA-OA: Research Funding: Celgene (Inst), Seagen (Inst), AbbVie (Inst), Bristol Myers Squibb/Medarex (Inst), Sanofi (Inst), GlaxoSmithKline (Inst). Patents, Royalties, Other Intellectual Property: PSA vaccine patent.\u003c/p\u003e\n\u003cp\u003eNA: Consulting or Advisory Role: Kite/Gilead, BMS, Legend Biotech, Invivyd; Research Funding: Kite/Gilead (Inst).\u003c/p\u003e\n\u003cp\u003eSA: Leadership ACCRU; Consulting or Advisory Role: Pfizer, Sanofi: Research Funding: GlaxoSmithKline, Amgen, Karyopharm Therapeutics, Janssen Oncology (Inst), Celgene/Bristol Myers Squibb (Inst); Honoraria: Janssen, GSK, Sanofi.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAH, AV, AN, ES, HS, DC, CS, KG and AMK: These authors declare no competing financial interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are not publicly available due to HIPPA but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBerdeja JG, Madduri D, Usmani SZ, et al: Ciltacabtagene autoleucel, a B-cell maturation antigen-directed chimeric antigen receptor T-cell therapy in patients with relapsed or refractory multiple myeloma (CARTITUDE-1): a phase 1b/2 open-label study. Lancet 398:314-324, 2021\u003c/li\u003e\n\u003cli\u003eMunshi NC, Hege K, San-Miguel J: Idecabtagene Vicleucel in Relapsed Myeloma. Reply. N Engl J Med 384:2357-2358, 2021\u003c/li\u003e\n\u003cli\u003eSan-Miguel J, Dhakal B, Yong K, et al: Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma. N Engl J Med 389:335-347, 2023\u003c/li\u003e\n\u003cli\u003eRodriguez-Otero P, Ailawadhi S, Arnulf B, et al: Ide-cel or Standard Regimens in Relapsed and Refractory Multiple Myeloma. N Engl J Med 388:1002-1014, 2023\u003c/li\u003e\n\u003cli\u003eFaruqi AJ, Ligon JA, Borgman P, et al: The impact of race, ethnicity, and obesity on CAR T-cell therapy outcomes. Blood Adv 6:6040-6050, 2022\u003c/li\u003e\n\u003cli\u003eKarmali R, Machhi R, Epperla N, et al: Impact of race and social determinants of health on outcomes in patients with aggressive B-cell NHL treated with CAR-T therapy. Blood Adv 8:2592-2599, 2024\u003c/li\u003e\n\u003cli\u003eLocke FL, Siddiqi T, Jacobson CA, et al: Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity. Blood 143:2722-2734, 2024\u003c/li\u003e\n\u003cli\u003ePeres LC, Oswald LB, Dillard CM, et al: Racial and ethnic differences in clinical outcomes among patients with multiple myeloma treated with CAR T-cell therapy. Blood Adv 8:251-259, 2024\u003c/li\u003e\n\u003cli\u003eKumar S, Paiva B, Anderson KC, et al: International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 17:e328-e346, 2016\u003c/li\u003e\n\u003cli\u003eWesson W, Dima D, Suleman N, et al: Timing of Toxicities and Non-Relapse Mortality Following CAR T Therapy in Myeloma. Transplant Cell Ther 30:876-884, 2024\u003c/li\u003e\n\u003cli\u003eDhodapkar KM, Cohen AD, Kaushal A, et al: Changes in Bone Marrow Tumor and Immune Cells Correlate with Durability of Remissions Following BCMA CAR T Therapy in Myeloma. Blood Cancer Discov 3:490-501, 2022\u003c/li\u003e\n\u003cli\u003eDong J, Garacci Z, Buradagunta CS, et al: Black patients with multiple myeloma have better survival than white patients when treated equally: a matched cohort study. Blood Cancer J 12:34, 2022\u003c/li\u003e\n\u003cli\u003eMikhael J, Cichewicz A, Mearns ES, et al: Overall Survival in Patients With Multiple Myeloma in the U.S.: A Systematic Literature Review of Racial Disparities. Clin Lymphoma Myeloma Leuk 24:e1-e12, 2024\u003c/li\u003e\n\u003cli\u003eAhmed N, Shahzad M, Shippey E, et al: Socioeconomic and Racial Disparity in Chimeric Antigen Receptor T Cell Therapy Access. Transplant Cell Ther 28:358-364, 2022\u003c/li\u003e\n\u003cli\u003eSnyder S, Chung KC, Jun MP, et al: Access to Chimeric Antigen Receptor T Cell Therapy for Diffuse Large B Cell Lymphoma. Adv Ther 38:4659-4674, 2021\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline clinical and disease characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinority, N = 46\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite, N = 177\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eAge (median, years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e61.5 (41.0-83.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e66.0 (34.0-84.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e20 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e105 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eECOG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e2 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e22 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e35 (78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e125 (79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e7 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e12 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eHeavy Isotype\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;IgA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e7 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e35 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;IgG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e29 (63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e104 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Light chain disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e10 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e37 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eLight Chain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Kappa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e26 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e109 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Lambda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e20 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e67 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eR-ISS stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e5 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e34 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e12 (39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e70 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e14 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e35 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eHigh-risk cytogenetics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Deletion 17p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e7 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e38 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;t(4;14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e4 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e18 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;t(14;16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e8 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003ePlasma cell leukemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e3 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eEMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e16 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e67 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eCrCl \u0026lt;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e10 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e15 (8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003ePrior transplant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e37 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e148 (84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003ePrior lines of therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e5.0 (0.0-12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e6.0 (1.0-13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eRefractory Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Bortezomib refractory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e28 (61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e95 (54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Carfilzomib refractory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e33 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e125 (71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Lenalidomide refractory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e36 (78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e137 (77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Pomalidomide refractory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e38 (83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e131 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Anti-CD38 refractory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e42 (91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e163 (92.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003ePrevious anti-BCMA exposed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e7 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e22 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003eProduct\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cilta-Cel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e16 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e57 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.7959%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ide-Cel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e30 (65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.449%;\"\u003e\n \u003cp\u003e120 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2653%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Clinical trial eligibility by race as based on ejection fraction, creatinine clearance, presence of plasma cell leukemia, prior BCMA exposure, and AL amyloidosis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinority\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;N = 46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;N = 177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal number of Ineligible patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e19 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e42 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEF \u0026lt; 45%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrCl \u0026lt;45 ml/min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e10 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e15 (8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConcomitant AL Amyloidosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e5 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious anti-BCMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e7 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e22 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003eNote: Values are presented as n (%). p-values are from Pearson\u0026rsquo;s Chi-squared test.\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Summary of non-hematologic toxicities by race\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinority (N = 46), n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite N = 177, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eCRS any grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e40 (87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e142 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eMax CRS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e6 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e35 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e28 (61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e101 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e12 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e39 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eICANS any grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e14 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e32 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eMax ICANS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e32 (70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e141 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e6 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e20 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e13 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eInfection of any grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e14 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e37 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eHospitalization (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e11 (8, 17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e10 (7, 15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eParkinsonian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Hospitalization duration is reported as median (interquartile range).\u003c/p\u003e\n\u003cp\u003e*P-values were calculated using Pearson\u0026apos;s Chi-squared test; Fisher\u0026apos;s exact test; and Wilcoxon rank sum test.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"blood-cancer-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bcj","sideBox":"Learn more about [Blood Cancer Journal](http://www.nature.com/bcj/)","snPcode":"41408","submissionUrl":"https://mts-bcj.nature.com/cgi-bin/main.plex","title":"Blood Cancer Journal","twitterHandle":"@bloodcancerjnl","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7208369/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7208369/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eRacial and ethnic minorities have been underrepresented in pivotal trials of idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), limiting the generalizability of findings. This multicenter retrospective study evaluated real-world outcomes in minority patients (MP) versus White patients (WP) treated with cilta-cel or ide-cel across five U.S. centers between May 2022 and April 2024. Among 223 patients, 21% self-identified as racial minorities (39 Black, 2 Asian, 2 Hispanic, 3 other). MPs were younger at infusion (mean age 61.3 vs. 64.8 years; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012) and more likely to have impaired renal function (CrCl\u0026thinsp;\u0026lt;\u0026thinsp;45 mL/min: 22% vs. 8.5%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011). Other baseline disease characteristics were similar between groups. At 6 months, overall response rate (ORR) was 84% in MPs and 71% in WPs. Median progression-free survival was 16.1 months in MPs and 14.1 months in WPs, while median overall survival was 26.4 vs. 27.9 months, respectively; these differences were not statistically significant. Toxicity profiles were comparable overall; however, MPs experienced significantly higher rates of grade 4 neutropenia (41% vs. 21%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01 ). In this real-world cohort, cilta-cel and ide-cel demonstrated similar efficacy and safety in MPs compared to WPs. These results support the use of BCMA-targeted CAR-T therapies across diverse populations and highlight the continued need to improve minority representation in clinical trials to ensure equitable access and outcomes in multiple myeloma care.\u003c/p\u003e","manuscriptTitle":"Outcomes of CAR T-Cell Therapy in Relapsed/Refractory Multiple Myeloma by Race: A Multicenter Real-World Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 10:26:31","doi":"10.21203/rs.3.rs-7208369/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2025-08-28T11:07:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-08-18T19:33:08+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-08-11T22:31:18+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-08-03T20:52:11+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-07-28T15:41:07+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-07-28T14:59:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T10:50:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-28T10:44:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Blood Cancer Journal","date":"2025-07-25T18:53:20+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2025-07-25T09:52:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"blood-cancer-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bcj","sideBox":"Learn more about [Blood Cancer Journal](http://www.nature.com/bcj/)","snPcode":"41408","submissionUrl":"https://mts-bcj.nature.com/cgi-bin/main.plex","title":"Blood Cancer Journal","twitterHandle":"@bloodcancerjnl","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e65a5a01-73f8-494f-9531-9bee42d7cab6","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":52244759,"name":"Biological sciences/Cancer/Cancer therapy/Cancer immunotherapy"},{"id":52244760,"name":"Health sciences/Medical research/Translational research"}],"tags":[],"updatedAt":"2025-11-22T08:13:32+00:00","versionOfRecord":{"articleIdentity":"rs-7208369","link":"https://doi.org/10.1038/s41408-025-01419-1","journal":{"identity":"blood-cancer-journal","isVorOnly":false,"title":"Blood Cancer Journal"},"publishedOn":"2025-11-21 05:00:00","publishedOnDateReadable":"November 21st, 2025"},"versionCreatedAt":"2025-07-31 10:26:31","video":"","vorDoi":"10.1038/s41408-025-01419-1","vorDoiUrl":"https://doi.org/10.1038/s41408-025-01419-1","workflowStages":[]},"version":"v1","identity":"rs-7208369","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7208369","identity":"rs-7208369","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}